CHALLENGES AND NOVEL SOLUTIONS TO PROMOTING ADHERENCE TO HOME-BASED COGNITIVE ASSESSMENT

Abstract New technologies now allow for home-based self-assessment of cognition to promote the early detection and treatment of cognitive decline. Early detection has a multitude of benefits for the individual and for our scientific understanding of cognitive impairments and possible treatments. However, for these solutions to be effective, they will likely require long-term adherence to assessment protocols to detect longitudinal change, and like many health behaviors, adherence can be a major challenge. This presentation will provide an overview of the Adherence Promotion with Person-centered Technology (APPT) project, which aims to develop a tailored, smart reminder system that infers participants’ contexts and motivations to provide just-in-time support to facilitate cognitive assessment adherence. Among other studies, this overview will include discussion of a recently completed focus group study (N = 42) that was used to understand motivations and potential barriers to home-based assessment and preferences for adherence support, a recently completed pilot study (N = 44) in which the adherence support system was initially tested and refined, and a series of survey studies (total N > 200) that examined older adults’ attitudes toward wearable technologies to detect cognitive decline. The talk will conclude with discussion of an upcoming randomized controlled trial to test the efficacy of the newly developed system with respect to promoting long-term adherence to cognitive assessment via smartphone technologies.

United States,3. Boston University,Boston,Massachusetts,United States,4. Columbia University Medical Center,New York City,New York,United States,5. Boston University Chobian & Avedisian School of Medicine,Boston,Massachusetts,United States,6. Tufts Medical Center,Boston,Massachusetts,United States Early detection of Alzheimer's disease is needed but cognitive screeners, used widely in research and clinical settings, suffer from poor sensitivity and specificity.Acoustic features of speech are altered in Alzheimer's disease and may aid detection of cognitive impairment.We sought to test whether acoustic metrics from a cognitive screener differentiate individuals with cognitive impairment from those who are cognitively normal.We extracted 38 acoustic features from digital voice recordings of the Mini-Mental Status Examination repetition task from Long Life Family Study participants using the openSMILE toolkit.Highly correlated features (r>0.9) were removed.Cognitive status (impaired versus cognitively normal) was determined through consensus review of neuropsychological testing and informant interviews.Bayesian Information Criterion-based stepwise regression including 24 acoustic variables and retaining age, sex, education, and MMSE score in all models was used to identify predictors of cognitive status.Acoustic features from preliminary data included 277 participants (mean age 74.8±12.3 years old, 57% females, 34% cognitively impaired due to oversampling).Stepwise selection identified greater loudness (i.e., signal intensity; p<0.001), smaller pitch changes (p=0.007), and lower Harmonics-to-Noise Ratio (i.e., a metric of voice quality; p=0.017) as significantly associated with cognitive impairment.A model with MMSE, demographics, and acoustics had a higher discriminative value for cognitive status (AUC 0.95, sensitivity=0.97,speci-ficity=0.73)than the model without acoustics (AUC = 0.94, sensitivity=0.97,specificity=0.63).Overall, acoustic features from a brief (i.e., 3 second) repetition task were associated with cognitive impairment and added information beyond traditional scoring that increased the specificity of a cognitive screener.
from the Long Life Family Study.Depression status was positive for participants with a self-reported depression diagnosis or high depressive symptoms (i.e., a CESD-10 score≥10) at testing.We used logistic regression models with Generalized Estimating Equations adjusted by age, sex, education, and within-family relatedness to identify linguistic features associated with depression status (Bonferronicorrected threshold of p<.001).The sample included 61 participants with evidence of depression and 539 participants without (mean age=72.1±10.9years, female=63%).A lower percentage of verb use in delayed recall was significantly associated with depression (Odds Ratio [OR]=0.71,CI 0.55-0.93,p=.0001).Additionally, 3 immediate recall features (verbs, OR=0.71; prepositions, OR=1.30; differentiation words, OR=1.30) and 5 delayed recall features (function words, OR=0.68; prepositions, OR=1.50; future tense, OR=0.48; cognitive process words, OR=0.78; past tense, OR=0.74) were significant at a nominal level (p=.009 to p=.035).We identified linguistic features from paragraph recall responses that predict depression and were largely distinct from those associated with cognitive impairment as only two features overlapped.Linguistic analyses of spoken responses may help us understand contributors to test performance and distinguish between cognitive impairment and depression.

CHALLENGES AND NOVEL SOLUTIONS TO PROMOTING ADHERENCE TO HOME-BASED COGNITIVE ASSESSMENT
Walter Boot, Ibukun Fowe, Shenghao Zhang, Michael Dieciuc, and Andrew Dilanchian, Florida State University, Tallahassee, Florida, United States New technologies now allow for home-based self-assessment of cognition to promote the early detection and treatment of cognitive decline.Early detection has a multitude of benefits for the individual and for our scientific understanding of cognitive impairments and possible treatments.However, for these solutions to be effective, they will likely require long-term adherence to assessment protocols to detect longitudinal change, and like many health behaviors, adherence can be a major challenge.This presentation will provide an overview of the Adherence Promotion with Person-centered Technology (APPT) project, which aims to develop a tailored, smart reminder system that infers participants' contexts and motivations to provide just-in-time support to facilitate cognitive assessment adherence.Among other studies, this overview will include discussion of a recently completed focus group study (N = 42) that was used to understand motivations and potential barriers to homebased assessment and preferences for adherence support, a recently completed pilot study (N = 44) in which the adherence support system was initially tested and refined, and a series of survey studies (total N > 200) that examined older adults' attitudes toward wearable technologies to detect cognitive decline.The talk will conclude with discussion of an upcoming randomized controlled trial to test the efficacy of the newly developed system with respect to promoting long-term adherence to cognitive assessment via smartphone technologies.

ACCESS TO DENTAL CARE AND ORAL HEALTH INEQUITIES AMONG DIVERSE POPULATIONS IN THE UNITED STATES AND CHINA
Chair: Xiang Qi Co-Chair: Xi Chen Discussant: Elisa Ghezzi Although the oral health status of the world population has improved over the years, structural and societal inequities in dental care and oral health are pervasive with older adults.This symposium discusses findings from three studies that examine structural and societal determinants of dental care and oral health inequities among diverse populations in the US and China.Mao's study investigated correlates of dental care utilization among informal dementia caregivers in the US.Findings demonstrate that spousal caregivers and those who provide intensive care are less likely to visit a dentist.These findings suggest that dementia caregiver support intervention strategies should target these populations to improve dental care-seeking behaviors.Qi's study examined the population attributable fraction of poor oral health on incident dementia in comparison with other modifiable risk factors.This study found that poor oral health, including edentulism and oral health problems, is a significant risk factor for incident dementia.The study highlights the need to integrate dental care as an integral component of a comprehensive approach to promoting cognitive health.Qu's study explored social structural disparities in dental care utilization among adults in China's megacities.This study revealed that social structural factors, such as hukou status, occupational status, and city of residence, are associated with disparities in dental care utilization.Overall, these studies shed light on important factors that impact dental care utilization and oral health.Addressing disparities in dental care utilization and oral health should be a priority in promoting overall health and well-being, particularly among vulnerable populations.

POPULATION ATTRIBUTABLE FRACTION OF POOR ORAL HEALTH FOR THE INCIDENCE OF DEMENTIA: A POPULATION-BASED COHORT STUDY
Xiang Qi, and Bei Wu, New York University, New York City, New York, United States Emerging evidence indicates a positive association between suboptimal oral health and increased risks of dementia.Despite the preventable and treatable nature of many oral health problems, oral health has not been considered in the risk factors for dementia that shape public health policy and research priorities.We aimed to quantify and compare the fractions of incident dementia attributable to poor oral health and other modifiable risk factors.The research included a nationally-representative sample of 15,474 cognitively intact adults aged≥50 from the Health and Retirement Study, with the outcome of incident dementia between 2006 to 2016.We estimated the multivariate-adjusted hazard ratio (HR) and population attributable fraction (PAF) of edentulism and nine risk additional dementia factors.Additional analyses were conducted on 1,239 individuals who completed the "Dental Health Module" in 2008, examining oral health problems as an exposure.Edentulism was associated with a higher risk of dementia for both men (HR,1.38;95%CI,)and women (HR,1.32;95%CI,.The PAF of edentulism for dementia was 4.64%, which exceeded that of hearing impairment (3.58%) and hypertension (2.90%).Oral health problems were also a significant factor for men (HR,2.01;95%CI,)and women (HR, 1.15; 95% CI, 1.02-1.30),with a PAF of 11.84% among men, the second-largest following less education (22.60%).The substantial estimated proportion of dementia attributed to poor oral health in the aging population, particularly in men, warrants more attention.Dental care should be an integral component of a comprehensive approach to promoting cognitive health.Informal dementia caregivers tend to report more negative health impacts from the caregiving role, higher levels of unmet needs, and lower levels of service utilization compared to caregivers of persons with other types of illnesses.There remains a gap in knowledge of understanding unique correlates of dental care utilization among informal dementia caregivers.As guided by the Andersen model, this study examined correlates of dental care utilization among U.S. informal dementia caregivers.Data came from the Behavioral Risk Factor Surveillance System collected in 2016, 2018, and 2020 (n=2,931).Respondents were selected when they reported providing regular care or assistance to a friend or family member who has Alzheimer's disease, dementia, or other cognitive impairment disorder.Dental care utilization was dichotomized into "yes" versus "no" within the past year.Caregiving-related characteristics included caregiver role (e.g., spouse, adult child, other relative, and friend), intensity of care, duration of care, and type of care.Other correlates included caregiver characteristics, health behaviors, and physical and oral health needs.Findings from stepwise logistic regression models demonstrate that being a spousal caregiver, providing more than 20 hours of care per week, being male, having high school or less education, being low-income, unemployed, current smoker, having no health insurance, no current alcohol use, or less than adequate sleep was associated with a lower likelihood of vising a dentist within the past year.The findings suggest targeting spousal caregivers and those who provide intensive care to improve dental careseeking behaviors in dementia caregiver support intervention strategies.